Assessing the utility of serum Cholinesterase, Lactate dehydrogenase and Albumin/Globulin ratio in differentiating liver diseases

Introduction: Variety of liver diseases including alcoholic liver disease (ALD) is responsible for liver related morbidity and mortality in India. Distinguishing ALD from non-alcoholic steatohepatitis (NASH) and viral hepatitis may not be easy. The history of alcohol intake may be unreliable. Clinico-pathological findings may not yield the correct diagnosis. So aim of our study was a) To compare the patients of ALD with those of NASH and acute viral hepatitis by biochemical parameters like serum Cholinesterase, Lactate dehydrogenase and Albumin/Globulin ratio and b) To assess the utility of these parameters in differentiating patients of ALD from NASH and acute viral hepatitis. Materials and Method: Study was carried out on 50 patients of ALD, 35 patients of NASH and 35 patients of acute viral hepatitis. All the patients were in the age group of 20-70. Selection criteria were history of alcohol, clinical examination, raised serum bilirubin levels and viral studies. Blood sample analysis was done for bilirubin, cholinesterase, lactate dehydrogenase, total protein and albumin by Diazo, kinetic, biuret and BCG method respectively on fully automatic analyser. Statistical analysis was done by Student unpaired ‘t' test. Results: The patients of NASH and acute viral hepatitis had normal serum ChE, albumin and LDH levels compared to patients of ALD who had lower serum ChE and albumin with higher LDH levels. These differences in the findings were statistically significant (P<0.05).Lowered serum ChE and albumin levels with A/G ratio reversal might be because of long term alcohol induced hepatic injury resulting in lowered synthetic capacity. Increased LDH in ALD might suggest a hypoxic injury and a progression towards necrosis. Normal serum ChE, A/G ratio and LDH in patients of NASH as well as acute viral hepatitis suggested that hepatic synthetic capacity is intact with no hepatocyte hypoxia. Conclusion: So our study concluded that NASH and viral hepatitis patients had less hepatocyte injury and fair prognosis as compared to ALD patients who had more hepatic loss with worse prognosis. Further our study has drawn a conclusion that we can biochemically differentiate NASH and acute viral hepatitis from ALD on the basis of parameters like ChE, LDH and A/G ratio. This finding can be used by clinicians to support their diagnosis whenever clinical dilemma occurs.